Coeliac disease, celiac disease

Coeliac disease is a lifelong ‘auto-immune disease’ caused by gluten according to Official coeliac websites. It affects about one in a hundred people. Apparently, only 24% of people who have it, have been diagnosed as having it, according to Coeliac UK. And if it affects a direct family member, your chances of getting rise from one in a hundred to one in ten. Gluten is found in wheat, rye and barley.

I love the bits about ‘caused’ by gluten; and that 76% of people who have it, don’t know they have it. So how can anyone tell it is 76% not 72%?

Of course it is not ‘caused’ by gluten. The truth is that approximately 40% of the population have a genetic predisposition to coeliac disease yet it only manifests itself in about 1% of them. The question to answer is ‘Why do some people have gluten intolerance?’

A classic cause of an allergy, for example, is to have lost certain commensal (good) bacteria that would have processed the ‘dangerous’ food for you. It is now known that an auto-immune system condition can be explained by occurrences in your gut that bring on an attack by your white cells, which then attack similar structures elsewhere in the body. The issue is, what occurences?

Coeliac Disease and gut bacteria

When an individual with celiac disease eats a food containing gluten, the immune system immediately starts attacking and damaging the small intestine lining.

What is clear is that people of a certain genetic make-up (who express a gene called DQ8) have the potential for gluten intolerance, but not all are actually smitten. In fact, just 2-3%. So what’s going on?

In 2015, a team from the Digestive Health Research Institute at McMaster University in Canada, lead by Dr. Elena Verdu engineered the gut microbiomes of mice to have no bacteria (clean mice), only good bacteria (pathogen-free) or a normal healthy gut mix including pathogens such as Proteobacteria, such as Escherichia, Streptococcus, Staphylococcus and Helicobacter.

By giving the pathogen-free mice gluten, they saw an immediate pick up in immune lymphocytes in the blood, and damage to the gut wall villi, with increase in death of intestinal lining cells. Interestingly, the clean mice did not have the auto-immune response.

The most interesting group though were the ‘normal’ mice. When they received gluten, they had the biggest reaction of all. Maybe it was the Proteobacteria?

When the clean mice received Escherichia coli from a patient with celiac disease, they too showed all the responses.

When they gave newborn mice an antibiotic (vancomycin) their gluten reaction became worse. This was because the antibiotic damaged levels of commensal bacteria which normally keep the pathogens in check. After the antibiotic, higher levels of Proteobacteria were seen, more ‘gluten sensitivity’ and a greater immune response.

The immune response could be due to the greater presence of pathogens and/or the Proteobacteria somehow boost the immune response to gluten.

The conclusion is however clear. An imbalanced microbiome lies behind the gluten ‘intolerance and immune response.

In August 2016, the research team at McMaster showed in a second study that mice that received Pseudomonas aeruginosa (Psa) from coeliac patients produced gluten sequences that stimulated inflammation in their gut wall. However, mice that had received strains of Lactobacillus metabolised and detoxified the gluten.

What is happening is that gluten cannot be metabolised by 40% of people because they have a genetic fault that does not allow the correct enzymes to be produced. In these cases, the majority of people who have the genetic problem find their gut bacteria do the job for them. In a limited number of cases, they have lost the correct helpful bacteria and so become fully gluten intolerant.

The bottom line
The next step is simply to find out the gut bacteria that can best help the digestion of gluten, and probiotics could then be the answer.

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Chris Woollams Health Watch is an evidence-based, information-only website. We produce short synopses of the latest research in easy-to-understand language. We do NOT answer questions about individual illnesses. However, you can leave comments about the website.